Scheduling

Recommend obtaining USMLE Step 1 scores above 225 to compete for interviews – and equivalent or better Step 2 CK by October in the year prior to interview season.

Interviews are November to January and, with ~140 programs nationwide, we advise ranking about 10 programs to ensure acceptance.

ERAS applications are due in September – therefore, schedule Anesthesiology electives locally well ahead of this to obtain the needed letters of support.

In planning, please remember that a good Anesthesiologist is an outstanding internist – with skills in cardiopulmonary assessment and management, fluid and electrolyte management and organ protection. Rotations should reflect these needs.

Scheduling Guidelines

Use July to prepare for Step II and begin your ERAS application

Avoid scheduling an away elective in August while you are completing your ERAS application – it is easier to avail yourself of local resources (SOM and faculty) and to meet for your Chair’s/Department letter

Recommend taking Step II CK by September, Step II CS by October (want to post passing scores as early as possible)

Schedule time off for interviewing in October or November, an elective in December is helpful to do additional local interviews

If need to do multiple interviews in another geographic location, schedule an elective there and time off to accommodate interviews

Delay required EM rotation until after January

Schedule to do your Sub-I in FM (August/September if you need a letter)

A. Year IV ROTATIONS—CHOOSE WISELY!

You are paying a lot for this year. Don’t waste the money or the opportunity. You are going to be a real doctor and take care of real patients.

1. Elective Rotations in field of interest

Medicine electives

Explore specialties that you are interested in pursuing as a career (Heme/Onc, GI, geriatrics, etc.)

Choose electives in areas of weakness or perceived weakness

Choose electives to gain specific skills (e.g. cardiology so you can read an EKG or Pulmonary Medicine so you can interpret a chest film)

Choose electives that are difficult. If you are going into medicine you will likely do these rotations again as a resident. However, some things you need to do twice to gain expertise (e.g. Infectious Diseases, Nephrology)

Choose electives that are interesting

Don’t only do Medicine electives; 3 electives should be enough.

Choose subspecialty rotations. You will do a subinternship. You do NOT need another general medicine rotation.

Do not completely front load your schedule

You do not want to have done all meaningful electives in the first half of the year so that you have the light weight electives from January-graduation. You will be out of practice and not in the best shape for your internship.

Away electives

Away electives may improve your competitiveness at that program but don’t count on it! You cannot overcome average medical school performance and average USMLEs with a good clinical rotation. You are competing against a large pool of good candidates.

Do away electives in subspecialty Medicine to check out residency programs to gage your interest in the program.

Do away electives to check out a region or city or to see if you do well away from your family and social support system.

2. Sub Internship

Do your Sub I early, preferably before interviews

July and August are great months. Most residencies have a summer lecture series that orients new interns to Medicine and to taking care of sick patients (e.g. “Approach to Chest Pain”, Emergencies in Infections Diseases, etc). These lectures are a great review for USMLE and a great overview of Internal Medicine.

September and October are not too late.

Note: the highly competitive programs may want a letter from your Sub I but most programs do not.

3. Other required rotations (ER)

Emergency Medicine is a great review for USMLE. But remember there are limited positions in July, August, and September. Let the ER wanna-bees have those time slots.

4. Electives

Recommended electives—any subspecialty.

ID is highly recommended as they teach you to review a chart, do a great physical examination, develop a great differential diagnosis and read critically.

Critical care is required by some residencies. You will get an opportunity to learn to care for complex patients and do procedures.

Do choose non-Medicine electives. This is your last chance to learn things from the experts.

If you are going into primary care, consider urology (remember half your patients will be men!). Consider radiology; everyone gets an imaging test at some point in their care. Consider pre-operative consultation, ophthalmology, ENT, and dermatology; for all internists consider anesthesiology (remember you will be doing pre-op “clearance.” You need to understand the anesthesiologist’s point of view and you need to see what happens from the other end of the table. Also, it is a great way to do procedures.

5. Away rotations

Rehearsal rotations rarely help secure a residency in Internal Medicine. Do them to see if the program you are interested in is as good a fit as you think and to see if you will like living in a particular location.

September, October and November are good months to do away rotations. It is very difficult to secure an away rotation in July and August. Most schools are working on scheduling their own students. You may not get confirmation until just before the rotation and you may find you do not have a rotation at all.

6. Pros and cons of research electives

Exposure is good

Unless done early they do not improve chances or matching at research institutions. However, the experience and potential abstract may improve your application for fellowship

B. USMLE:

Step 1

What score is competitive for residency depends on the residency you want? Elite programs want great scores and AOA. For research institutions great scores and class rank aren’t enough; you need research too. However, there are wonderful programs that will take students with scores above 200.

A single failure does not preclude getting a good residency.

Step 2

Program directors value both Step 1 and 2. Some of us value Step 2 more than Step 1.

The good news is that a good Step 2 score can compensate for a poor Step 1 score… but only if you take it early enough.

When to take: the sooner the better. Try to take by the end of October. The longer you wait the more you will have to review. Get Step 2 done early!

If you had Internal Medicine at the beginning of Year 3 you may want to do your Sub I in July and then take August off to study and take Step 2.

If you took Internal Medicine at the end of Year 3 you may want to take July off to study and take Step 2.

There is a lot of ambulatory on Step 2. You may want to take ambulatory medicine before you take the exam.

C. LETTERS of RECOMMENDATION:

You need 3 letters of recommendation. Anyone applying to a University program also needs a chairman’s letter; this is a fourth letter. Even though the Chair doesn’t really know you it is an opportunity for you to meet with the chair and for the Chair to provide you with advice.

You should have at least one of your three letters and preferably two from Internal Medicine or subspecialty medicine. Your continuity preceptor is an excellent person to ask for a letter. He or she knows you and your performance over an extended period of time.

Ask your potential letter writers if they “feel comfortable writing you a really strong letter as you are planning to apply to some high powered places.”

D. APPLICATIONS

The number of places you apply to depends on your competitiveness.

If you are a marginal student (course failures, USMLE failure(s), etc) you need to apply to a lot of Medicine programs—100-150 programs including mostly if not all community programs.

On average most people should apply to 20-30 programs.

If you are a solid student—USMLEs of 220 and applying to in-State programs you can probably get away with 10-15 programs.

If you are applying to elite programs you need to apply to at least 30 programs including some less competitive programs.

The way you really know your competiveness is by the number of interviews you get.

It is best to apply to more that you want to interview at. You can always decline offers to interview. You can also accept offers and then decline later as more desirable program interviews are offered.

E. INTERVIEWS

Most are scheduled in November, December, and January

Plan to take one of these months off. If you are interviewing at a lot of programs you will need to make sure another month is a light-weight non-required rotation.

F. MISCELLANEOUS:

Complete your CV between Year 3 rotations. It is a wonderful feeling to be ready for ERAS.

Have your materials ready to submit to ERAS on time. This is one time you do NOT WANT TO BE LATE.

Scheduling:

Recommend taking Step IICK by September, StepII CS by October (want to post passing scores by January so programs know you have passed)

Schedule time off for interviewing in November or December, home elective in October to accommodate early local interviews

If need to do multiple interviews in other geographic location, schedule an elective there and time off to accommodate interviews

Do not schedule an away elective in August—you need to be around here while you are working on your ERAS application to avail yourself of local resources (SOM and faculty) and to meet with the Chair for your Chair’s letter for your application

Delay required EM rotation until after January

Schedule to do your Sub-I in ? Surgery

Schedule important personal events (wedding of your own or close friends, leisure travel, etc…)

Year 4 electives:

Strongly recommend: Cardiology, Radiology, Dermatology

Recommend: Endocrinology, Oncology, Infectious Disease

Recommend: Away elective if you are seriously considering a particular program/location which is out of your reach

Recommend taking electives that are of interest to you like: Law and Medicine, Advanced Surgical Skills, etc

Scheduling

Recommend taking Step IICK by September, StepII CS by October (want to post passing scores by January so programs know you have passed)

Schedule time off for interviewing in November or December, home elective in October to accommodate early local interviews

If need to do multiple interviews in other geographic location, schedule an elective there and time off to accommodate interviews

Do not schedule an away elective in August—you need to be around here while you are working on your ERAS application to avail yourself of local resources (SOM and faculty) and to meet with the Chair for your Chair’s letter for your application

Schedule important personal events (wedding of your own or close friends, leisure travel, etc…)

Year 4 electives

Strongly recommend: Orthopaedics at a site you are considering

Recommend: Away elective if you are seriously considering a particular program/location in that area

Letters of Recommendation

Three letters are sufficient- At least one from the Orthopaedic Chair or Program Director, (Surgery can be additional)

Scheduling:

In Step I and step IICK, a score of 240 or above is a competitive score. A score of 230-239 is considered an average score. A score of

Although it is recommended by the medical school to have step IICK get taken by September, our recommendations for students with step I score of 240 or above to delay their step IICK until their application has been sent out.

Students in the top quintile of their class will have a competitive application. Ones in the second quintile may still have a competitive application.

Alpha-Omega-Alpha will make the application more competitive

Honor score in the Surgery clerkship is highly recommended

Most academically oriented programs are looking for basic science research experience and/or publications

Schedule time off for interviewing in November through January.

If need to do multiple interviews in other geographic location, schedule an elective there and time off to accommodate interviews

Do not schedule an away elective in August—you need to be around here while you are working on your ERAS application to avail yourself of local resources (SOM and faculty) and to meet with the Chair for your Chair’s letter for your application

Schedule the Sub-I in Surgery

Schedule important personal events (wedding of your own or close friends, leisure travel, etc…) toward the end of the academic year

Year 4 electives:

Strongly recommend: ICU, SICU, Surgery, Radiology

Recommend taking electives that are of interest to you like: Law and Medicine, Advanced Surgical Skills, etc

Letters of Recommendation:

Three letters are sufficient- At least one from Otolaryngology. Letters from surgeons may appear stronger unless you have worked with a physician in research and they may write you a strong letter.

Do the things you are interested in or disciplines you plan to interview in early.

You can only do 3 away electives per SOM. Important to visit settings you are strongly considering. Especially important to evaluate the area to look for activities outside of the hospital. Evaluate academic vs non-academic. You need to do an academic center if you plan to specialize OR do research OR teach. You can also look for NIH grants to the institution as a sign of academic virtue. Evaluate how you learn best Hands on with patient OR READING. Free standing pediatric hospital offers another advantage for specialty even if NOT university affiliated.

Sub I

Recommended Sub I (medicine, surgery, pediatrics, family medicine) Ped subIs are seen very positive for peds residency. Can use PICU, NICU, nephrology, hematology-oncology, general peds floors at Childrens (Red, Yellow, Green and Rainbow)

Do early so you can get the grade back and use it as a positive.

Even if you do your subinternship in Oct or Nov, an addendum can be sent to ERAS so the program will know how well the student did during the subinternship

Other required rotations (ER, ambulatory)

Do the rotations relevant to your chosen discipline early. If you have no interest in ED (eg) leave it for those who want that discipline.

You are allowed to do Ambulatory Medicine in a Pediatric site.

Electives

Recommended electives: You are at the stage when everything you do will make you a better physician. Look for things that you may not have time to take in the next 4 years. Look for things you know nothing about to motivate you to continue studying. Part of your job this year is to develop habits that will improve time management AND your continued education. You must learn to self-initiate and self-criticize. The goal is to graduate as a Generalist not as a specialist. That’s what residency is for.

The SOM restricts you to 3 electives in the same field.

When to do – whenever it works in your schedule. If you think the experience would give you an advantage for interviewing, do it before you interview.

Away rotations

Are rehearsal rotations necessary, do they help? The best way to evaluate a program (and for them to evaluate you) is to BE THERE in a clinical setting. You need to determine interactions with faculty and ancillary staff and university and community. You need to evaluate the culture and attitudes of the community. An away also lets you evaluate the environment for activities, climate etc. You will not spend all of your time in the hospital. Make sure your non-medical interests are available!! It is good to get the sense of academic vs community vs free standing vs small/large program.

Pros and cons of research electives

A great way to assess your interest; to enhance your CV; to improve self-initiation and self-evaluation. It is not a must, but if you are considering an academic career, try it. Can provide you with a topic of discussion.

Out- of-country rotations

Same as #6

USMLE

Step 1 pass is 188

What score is competitive for residency? Check the website for that particular residency. Some places will list their cut-off.

When to take (Recommend that the student not delay on the taking of this exam. USMLE Step 2CK. Required to take the examination by the end of December to allow for a 1st attempt result to be reported by the end of January. USMLE Step 2CS. Required to take the examination by the end of October to allow.

For a 1st attempt result to be reported by the beginning of January. The take by dates for these exams were developed based on the reporting schedules, to allow for a 2nd attempt prior to graduation if the 1st attempt is unsuccessful. In order to be certified for graduation and allow sufficient time to have medical licensing forms completed, a passing result for both examinations has to be received by May 1) . Check the website. Some programs will not schedule for interview without a score; some will schedule but the score must be posted BEFORE you interview; some will not rank you until a score is posted.

Scores (what’s a competitive score for your field?)

Value of both 2 CK and 2CS in program director decision making. It gives another dimension in peds of ability to communicate. Clinical abilities are essential in this field.

Step 2 CK (knowledge test):
Students must post a first attempt score for Step 2 CK (knowledge test) by the end of October in the year they are applying to residency. Students must post a passing score by May of the year they plan to graduate

Step 2 CS (skills):
Students must take Step 2CS no later than February of the year they plan to graduate

Letters of Recommendation

Should comment if residency requires Chairman’s letter. Not always helpful. We do have a mechanism for providing the letter should you need it. Some programs do not like this letter because they prefer information from people who worked with you directly.

Recommendations other letters (e.g. How many in-field, other fields, etc.). Get out-of-field so that you show you have many strengths. Especially in pediatrics, we want to make sure can communicate with adults. Remember, parents/adult caregivers provide the care for children.

Who to ask for letter and when (SOM asks that letters of recommendation be submitted by September 15). Remember, the beginning of the academic year is July 1st for most SOM faculty. A lot of other things happen. 3rd year medical students and first year residency.

Not waiving the right to see the LOR before it is sent to ERAS sends out an alarm.

Interviews

When to schedule – No ramification .

Be sure you do not tell the residency that it is a Practice interview.

Always have questions!! Even if you ask the same question to everyone. Even if you know the program, still ask questions

Be sure you know something about the program before you interview. Review the website. Talk about specifics of that program.

Admit transcript issues up front.

Miscellaneous

Do extracurricular activities and community service make a difference? In peds we look for someone who can demonstrate sensitivity to children, can communicate with children, volunteer/exposure to children in any kind of activity. We look for a 3-dimentional person.

1. Electives to Consider:

Good Internal Medicine electives to consider are those that deal with chronic illness (Hematology-Oncology, Hospice and Palliative Care, Nephrology, Endocrinology/Diabetes Care).

Research electives may help, but they are not obligatory when applying for Psychiatry residency positions.

2. USMLE Step 2

Previous WSU students have advised taking Step 2 CS as close to the end of the Year III OSCE as possible.

It is wise to take Step 2 CK as early in the year as possible, preferably early fall. Programs submit rank lists in February; passing scores for both parts of Step 2 should therefore be available by February 1. Register early for your Step 2 exams, and leave time to retake the examination should you fail because some programs will not rank you without passing scores in USMLE 2 CK and 2 CS.

Because the Sub-Internship may be helpful to some students in preparing for Step 2, consider scheduling that required month early in Year IV.

3. Months Off

If you are an “on-time” graduate, you are allowed 3 months off during your fourth year. Most students take a month off to study for Step 2, one month to interview and one month at the end of the year (e.g., May).

4. Interviewing

The typical WSU student interviews in November, December and January, and takes one of those months off to do so.

Required Year IV months (Ambulatory, Emergency Medicine, and the Sub-I) generally allow 2 days off for interviewing. It may be difficult to schedule days off during Emergency given the nature of its shift work. Elective months typically allow 5 days for interviewing, but you need to give ample advance notice to all electives of the days you will be away for interviews.

Business attire is necessary. A suit for both genders and a tie for men are the norm.

Be prepared to answer the following with ease:

Why do you want to become a psychiatrist?

Tell me about yourself.

Come prepared to discuss any time off which has lengthened your medical school education. Be honest and up-front.

Interview days vary widely. You should expect to meet with residents in the program and be given contact information for later use.

5. Personal Statement

Do not borrow any material from internet websites to write your personal statements. Some residency programs have software which checks for plagiarized material.

It is acceptable to mention personal difficulties or a family history of psychiatric illness in your personal statement, but do not make that the theme of your statement.

If you have taken time off which has lengthened your medical school education, the personal statement is a good place to briefly mention the reason unless it was explained in the body of your ERAS application (Medical Education/Training Extended or Interrupted? Reason:).

6. Letters of Recommendation

Psychiatry programs do NOT routinely require or expect a chairman’s letter.

Try to obtain 2 letters from psychiatrists and one from an Internal Medicine or Pediatrics faculty member.

Try to have at least one letter come from a faculty member who knows you well and can describe you personally; one suggestion is your Year III Continuity Clinic preceptor.

A description of your psychosocial interactions with patients should be included in at least one of your letters of recommendation.

7. It is a good plan to complete a practice interview with someone who is experienced in interviewing.

8. After your residency interview

Training directors can NOT ask you how you have ranked their programs.

Within a week after you interview, send a brief, personal thank-you email to the program director and others with whom you interviewed. Mentioning what you like about the program is a good idea. A warm, hand-written thank-you note to the program director also is appreciated if you are interested in that program. Do not send holiday cards, etc.

Only rank the programs where you want to train. The match is a binding contract!

If you are in the Couples Match, make sure to cast a wide net, particularly if you or your partner is applying to a competitive specialty.

This memo is directed to all students contemplating entering further training after medical school in surgery or surgical subspecialties. It contains advice and guidance which we hope will assist you in the upcoming fourth year scheduling process.

With changes in residency training that have been occurring over the past few years, such as limitations of resident work hours, expanding mandated curriculum, etc. preparation for residency, especially in surgery, is increasingly important. On July 1st of the intern year, most program directors expect first year residents to hit the ground running. Thus, it is important to take advantage of opportunities during the fourth year of medical school to prepare oneself for surgical residency—to learn the skills necessary for surgical residency for which there is no longer time in the intern year to learn. The following general recommendations should be considered when planning your fourth year schedule:

Identify (now), an advisor in the surgical field for which you are interested. A list of these is available from the medical school and is available on the website. If you have difficulty locating an advisor, the student office in the Department of Surgery (313 916 2879) can assist you in this. Plan on meeting with this advisor before turning in your final schedule for the fourth year. Stick with this advisor or seek other advice from faculty when planning your applications , program choice, interviews, etc.

Plan to do a surgical sub-internship early in the year—July, August or September at the latest. For the next academic year, these will be offered at the downtown DMC campus and at the Henry Ford Hospital. There should be enough capacity to place everyone who selects a surgical Sub I. In past years, students headed to general surgery and its subspecialties (plastics, thoracic, vascular, etc) have done the subI early in the year to insure getting letters of recommendation, while those planning careers in Orthopedics, Urology, ENT, neurosurgery, etc have opted for later subIs (Jan to March) so that their early months can be used for electives in these specialties (i.e. so they can get a letter from a urologist, etc.) The process for signing up for a surgery subinternship will be sent out to you in the near future. It will involve contacting the surgery office and signing up BEFORE the general year 4 course lottery.

Make sure that you use the sub-internship to get a letter of recommendation (or more than one letter) from a surgical faculty member who will know you well after this rotation.

If you are planning or considering a surgical subspecialty such as Urology, Orthopedic surgery, Otolaryngology, Neurosurgery, Plastic Surgery, etc., plan an elective in this area again in the first few months of the academic year. This will serve to confirm or refute your choice of specialty areas and will offer you another chance of getting letters of recommendation.

Navigate to the website www.facs.org. This is the website of the American College of Surgeons. Go to the medical student section of this under the education area. This has valuable career advice from the American College of Surgeons. Of particular interest on this site is an area which is called “prerequisites in surgery and surgical subspecialties”. This is a listing of the knowledge and skills that are considered by program directors to be essential. They are essential for first year residents.

There are two categories: one is skills and knowledge that is expected on July 1 of your intern year. The other, the skills and knowledge that you are expected to acquire in your first postgraduate year. Use this as a guide for planning your fourth year schedule so that you enhance areas in which you may be weak.

The following specific rotations are highly recommended. It is not vital that you do these rotations, but only that you pick up the skills and knowledge that will help you in your surgical residency.

Intensive care unit. This can be either a surgical or medical ICU. Your advisor can help you choose good rotations. This will help you become more familiar with ICU care, communicating in the ICU setting and procedures.

Cardiology. We recommend a Cardiology inpatient floor or consult service in order to increase your skill set in reading EKGs, treating acute myocardial events, evaluating patients for preoperatively from a cardiac standpoint, etc.

Anesthesiology. This is a good opportunity to find how things go on the other side of the anesthesia screen. At the risk of finding out that things are much easier on the other side of the curtain, this is a good rotation to familiarize yourself with this part of care of the surgical patient and one you are likely not to get during surgical residency.

Radiology. This is a rotation that you may want to do later in the year or during a light interview month. Learn how to read x-rays, cross sectional imaging and hopefully get some exposure to ultrasound and other techniques.

Advanced surgery. This fourth year elective course was very successful and popular, now in its sixth year. This is a novel elective which is not available at any other US medical school (to my knowledge). This will more completely prepare you for upcoming surgical residencies. This includes simulation lab, surgical technique, surgical anatomy ultrasound and other non-patient care related opportunities. This will be offered Feb, March and April but may be offered at other times, depending on demand. We have a limited number of spots in this rotation, so priority will be given to students entering general surgery and then the surgical subspecialties.

These recommended five months of electives, when coupled with a surgical sub-internship, and a possible other surgical elective, and with your required courses in emergency medicine and ambulatory medicine should pretty much fill up your fourth year schedule.

Regarding letters of recommendation, you will need three letters for your application. It is highly desirable when applying to surgery programs, that at least two of these letters come from surgeons who are in the best position to evaluate you in compared to other applicants.

Make sure that you take Step 2 CK in July or August so that your scores are available for program directors. Surgical residencies are very competitive and you need to make sure that all your application information is in on time—you otherwise may be passed over for interviews.

Preparing for residency program selection: On the American College of Surgeons website, there is an area that is called the Little Red Book. This is a listing of surgery programs and their characteristics, resident requirements, etc. This is a good place to start when assembling a list of programs you are interested in. Take a proposed list sometime during the summer to your advisor for advice in paring down the list, etc.

In summary, plan your fourth year schedule carefully in order to take advantage of the opportunities to prepare yourself for your career. Meet with your advisor, talk to surgeons, residents, other students when evaluating programs in your career choice. All of this will prepare you well in launching your surgical career. Feel free to contact anyone in the Department of Surgery for questions, advice or simply encouragement.